Musculoskeletal Trauma Flashcards
(235 cards)
1
Q
What is the difference between upper and lower extremity injuries?
A
Upper extremities can be painful and sometimes debilitating but rarely threaten life; lower extremity injuries are generally associated with greater magnitude of force and greater secondary blood loss thus greater threat to life or limb
2
Q
T or F. Up to 80 percent of patients who suffer multi-system trauma do not experience significant musculoskeletal injuries.
A
False - they DO experience significant musculoskeletal injuries
3
Q
Incidences of musculoskeletal injury are ___ in frequency only to ___-___ injuries in trauma.
A
second ; soft-tissue
4
Q
What is the greatest single cause of musculoskeletal injuries?
A
Auto crashes
5
Q
Why is the musculoskeletal injury process more complicated and resulting in more damage than the disruption of an inert structural element of the body?
A
GENERAL: Complex arrangement of connective, skeletal, vascular, nervous, and muscular tissue endangered whenever significant kinetic forces are applied to the extremities
- Bone is alive and requires continuous supply of oxygenated circulation.
- Bone lies deep within muscle tissue; major nerves and blood vessels parallel it as they travel to the distal extremity.
- Complex arrangement of ligaments, cartilage, and synovial fluid that holds joints together while allowing movement at points of articulation
6
Q
What do musculoskeletal injuries usually result from?
A
Application of significant direct or transmitted blunt kinetic forces
7
Q
Muscular injury: What causes muscular injuries
A
Direct blunt/penetrating trauma; overexertion; or problems wih oxygen supply during exertion
8
Q
Muscular injury: What are the main types of muscular injuries?
A
- Contustion
- Compartment syndrome
- Penetrating injury
- Muscle fatigue
- Muscle cramp
- Muscle spasm
- Muscle strain
9
Q
Muscular injury: Generally muscular problems don’t significantly contribute to hypovolemia and shock, with what two exceptions?
A
(1) Severe contusions with large associated hematomas
(2) Penetrating injuries with extensive hemorrhage
10
Q
Muscular injury: How is a basic contusion formed?
A
Crush muscle between a blunt force and the skeletal structure beneath; damages both the muscle cells and blood vessels that supply them; small blood vessels rupture, leaking blood into the interstitial spaces causing pain, erythema, and then ecchymosis
11
Q
Muscular injury: Capillary beds engorge with blood and fluid shifts to the interstitial space leading to tissue ___.
A
Edema
12
Q
Muscular injury: How do large hematomas or significant muscular edemas effect injured limbs?
A
Increase the diameter of the injured limb especially compared to the other (swelling)
13
Q
Muscular injury: What is compartment syndrome?
A
Localized swelling resulting from damaging injury to the soft tissue within the compartment; the swelling increases the pressure within the compartment and reduces capillary blood flow to the muscle and nerve tissues
Reduced capillary flow causes release of histamine (worsens the swelling and pressure)
Building pressure all but stops blood flow; patient will still have distal pulse, capillary refill, and venous return from distal limb
14
Q
Muscular injury: What is the most common location for compartment syndrome?
A
Leg but also reported in arm, thigh, and hand injuries
15
Q
Muscular injury: How will a patient present if they have compartment syndrome?
A
- Complains of a deep and burning pain that appears out of proportion to the apparent injury
- Pain is not reduced by positioning
- Increase in pain when you (not your patient) move the extremity and stretch the muscles involved
- May report pain when flexing foot
- May report increased distal sensitivity or numbness due to nerve compression and injury
16
Q
Muscular injury: What might happen with massive wounds involving a large percentage of muscle body or injuring/severing a tendon?
A
May reduce the distal limb’s strength or render muscular control ineffective
17
Q
Muscular injury: What are other concerns with penetrating injuries?
A
- Introduction of infectious agents
- Damage muscle tissue
- Affect muscle’s blood supply
- Poor healing because of resulting infection, ischemia, or cobination
18
Q
Muscular injury: What is muscle fatigue?
A
Fatigue is a condition in which a muscle’s ability to respond to stimulation is lost or reduced through overactivity
19
Q
Muscular injury: What is the muscle environment like with exercise?
A
- Exercise drains muscle’s oxygen and energy reserves and causes accumulation of metabolic by-products
- Cell environment become hypoxic, toxic, and energy deprived
- Fewer and fewer muscle fibers are able to contract
20
Q
Muscular injury: What is a muscle cramp?
A
Cramping is a muscle pain resulting from overactivity, lack of oxygen, and accumulation of waste products; it is not really an injury but more of a spasm of the muscle tissue
21
Q
Muscular injury: What is muscle spasm?
A
Spasm is an intermittent or continuous contraction of a muscle
22
Q
Muscular injury: What is the extreme of muscle spasm?
A
Rigor mortis - an anoxic, rigid, whole-body muscle spasm that occurs after death
23
Q
Muscular injury: What is muscle strain?
A
Strain is an injury resulting from over-stretching of muscle fibers (muscles or tendon)
24
Q
Muscular injury: How will a patient present with muscle strain?
A
Site of injury is generally painful to palpitations; pain that limits use of the affected muscle
25
Joint injury: What do joint injuries include?
Sprains, subluxations, and dislocations
26
Joint injury: How do sprain injuries present?
- Acute pain at site
- Inflammation and swelling
- Ecchymotic discoloration (occurs over time but not usually during prehospital care)
- Continued used of the joint may lead to complete joint failure
27
Joint injury: What are three severity grades and criteria?
- Grade I: minor and incomplete tear; ligament is painful and swelling is usually minimal; join stable
- Grade II: significant but incomplete tear; swelling and pain range from moderate to severe; joint is intact but unstable
- Grade III: complete tear of the ligament; sprain may present as a fracture due to sever pain and spasm; joint is unstable
28
Joint injury: What is subluxation?
It is a partial displacement of a bone end from its position within a joint capsule; occurs as the joint separates under stress, stretching the ligaments
29
Joint injury: What is a dislocation?
It is a complete displacement of bone ends from their normal joint position; joint fixes in an abnormal position with noticeable deformity
30
Joint injury: How does a dislocation present?
- Noticeable deformity
| - Painful, swollen, and immobile site
31
Joint injury: What are some dislocation risks?
- Entrapping, compressing, or tearing blood vessels and nerves
- Serious ligament damage
- May involve injury to the joint capsule and articular cartilage
32
Bone injury: Describe the two types of fracture injuries.
Direct injury - auto bumper impacts patient's femur
Indirect injury - bike rider thrown over handle-pars and braces all with outstretched upper extremity; energy of impact is transmitted from hand to wrist to forearm to arm to shoulder to clavicle, which ends up fracturing
33
Bone injury: Why should you analyze the mechanism of injury for bone injuries?
Kinetic forces may be transmitted and cause injury far from point of impact
34
Bone injury: What are some other injuries suffered if broken bone ends displace?
Further injury to surrounding muscles, tendons, ligaments, veins, and arteries
35
Bone injury: What are indications of vascular damage?
Restricted blood flow to distal limb, increasing capillary refill time, diminishing pulse strength and limb temperature, and causing discoloration and paresthesia (a "pins-and-needles" sensation)
36
Bone injury: What are indications of nerve damage?
Distal paresthesia ("pins-and-needles" sensation), anesthesia (loss of sensation), paresis (weakness), and paralysis (loss of muscle control)
37
Bone injury: What are indications of muscle or tendon damage?
Trouble moving limb; compartment syndrome
38
Bone injury: What is a closed fracture?
A broken bone in which the bone ends or the forces that caused the fracture do not penetrate the skin
39
Bone injury: What is an open fracture?
A broken bone in which the bone ends or the forces that caused the fracture penetrated the surrounding skin; can also include instances like a bullet piercing the skin and breaking the bone
40
Bone injury: What is a hairline fracture?
Small crack in a bone that does not disrupt its total structure
41
Bone injury: What is an impacted fracture?
Break in a bone in which the bone is compressed on itself
42
Bone injury: What is a transverse fracture?
A break that runs across a bone perpendicular to the bone's orienation
43
Bone injury: What is an oblique fracture?
Break in a bone running across it at an angle other than 90 degress
44
Bone injury: What is a comminuted fracture?
Fracture in which a bone is broken into several pieces
45
Bone injury: What is a spiral fracture?
Curving of a break in a bone as may be caused by rotational forces
46
Bone injury: What isa fatigue fracture?
Break in a bone associated with prolonged or repeated stress
47
Bone injury: ___ ___ is a very infrequent but serious complication of fracture
Fat embolism
48
Bone injury: What happens with a fat embolism?
- The bone's disruption may damage adjacent blood vessels and release fat, stored in a semiliquid form, into the wound site where it enters the venous system and travels to the heart.
- The heart distributes the fat to the pulmonary circulation where it becomes pulmonary emboli
- Usually associated with severe or crush injuries or post-injury manipulation of larger long-bone fractures
49
Bone injury: What are the two types of pediatric fracture considerations?
-Greenstick fracture, which is a partial fracture of a child's bone; often complete a greenstick fracture by breaking the bone fully to ensure proper healing
- Epiphyseal fracture, which is a disruption of the epiphyseal plate of child's bone; epiphyseal growth plates are weak spots in long bones
- ---Most commonly find reduction/halt in bone growth condition in the proximal tibia
50
Bone injury: How does aging affect the musculoskeletal system?
Gradual, progressive decrease in bone mass and collagen restructure beginning about age 40, which results in bones that are less flexible, more brittle, and more easily fractured; heal more slowly
51
Bone injury: What is a common degenerative bone condition in geriatric patients?
Osteoporosis, which is weakening of bone tissue due to loss of essential minerals, especially calcium; typically affects women more than men
52
Bone injury: What are pathological fractures?
Fractures resulting from disease pathologies that affect bone development or maintenance
EX: tumors of the bone, periosteum, or articular cartilage
53
Long bones are smallest through the ___ and largest at the ___ ___ or ___.
diaphysis ; epiphyseal area ; joint
54
Why is the external extremity diameter greatest surrounding the mid-shaft? Why is this notable?
Due to the placement of skeletal muscle; significant when looking at the potential for nervous or vascular injury
55
Why are areas around joints further endangered in musculoskeletal injuries?
Because blood vessels supplying the epiphysis enter the long bone through the diaphysis; the distal bone tissue may die without adequate circulation, destroying the joint and its function
56
What are some complications that can result from long-bone fractures and movement/manipulation?
- Internal trauma
- Increased likelihood of introducing bone fragments or fat emboli into the venous system (causing pulmonary embolism)
- Muscle spasm
57
What are some conditions that impair the bone repair cycle?
Smoking, infection, poor health, diabetes, and use of NSAIDs and immunosuppressive drugs
58
Inflammatory/degenerative conditions: What condition is characterized by acute or chronic inflammation of the bursae, the small synovial sacs that reduce friction and cushion ligaments and tendons from trauma?
Bursistis
59
Inflammatory/degenerative conditions: What are some causes of bursitis?
Repeated trauma, gout, infection, or unknown etiologies
60
Inflammatory/degenerative conditions: How does a patient with bursitis present?
Localized pain, selling, and tenderness at or near a joint; commonly affected locations include the olecranon (elbow), area just above the patella, and the shoulder
61
Inflammatory/degenerative conditions: What condition is characterized by inflammation of a tendon and its protective sheath an has presentation similar to bursitis?
Tendonitis
62
Inflammatory/degenerative conditions: What are common causes of tendonitis?
Repeated trauma to a particular muscle group; usually affects the major tendons of the upper and lower extremity
63
Inflammatory/degenerative conditions: What condition is the inflammation of a joint, frequently due to damage or destruction of the joint's cartilage?
Arthritis
64
Inflammatory/degenerative conditions: What are the three most common types of arthritis?
Osteoarthritis, rheumatoid arthritis, and gout
65
Inflammatory/degenerative conditions: What is the most common type of connective tissue disorder?
Osteoarthritis
66
Inflammatory/degenerative conditions: How is osteoarthritis characterized?
General degeneration ("wear-and-tear") of articular cartilage that results in irregular bony overgrowths
67
Inflammatory/degenerative conditions: What are signs and symptoms of osteoarthritis?
Stiffness, diminished movement in the joints, visible joint enlargement (especially in the fingers); predisposing factors include trauma, obesity, and aging
68
Inflammatory/degenerative conditions: What condition is a chronic, systemic, progressive, and debilitating disease resulting in deterioration of peripheral joint connective tissue?
Rheumatoid arthritis
69
Inflammatory/degenerative conditions: How is rheumatoid arthritis characterized?
Inflammation of the synovial joints, which causes immobility, pain, increased pain on movement, and fatigue
70
Inflammatory/degenerative conditions: Who is more likely to be affected by rheumatoid arthritis?
Women (2-3 times more likely)
71
Inflammatory/degenerative conditions: What condition is an inflammation in joints and connective tissue produced by an accumulation of uric acid crystals?
Gout
72
Inflammatory/degenerative conditions: Who is more likely to have gout?
Men because they have higher concentrations of uric acid in the blood
73
Inflammatory/degenerative conditions: What is uric acid?
A metabolism end-product not easily dissolved
74
Inflammatory/degenerative conditions: What are the signs and symptoms of gout?
peripheral joint pain, swelling, and possible deformity
75
Inflammatory/degenerative conditions: What is pseudogout?
A gout-like disease cased by the deposition of a crystalline substance similar to uric acid
76
Inflammatory/degenerative conditions: What condition is a joint inflammation caused by a tick-introduced infectious agent?
Lyme disease
77
Inflammatory/degenerative conditions: How will a patient with lyme disease present?
Small red lesions, fever, fatigue, headache, muscle/joint pain; untreated it can lead to arthritis
78
Injury assessment: How do you perform a pelvic ring stability check?
Direct firm pressure downward then inward on the iliac crests, and then directing gentle downward pressure on the symphysis pubis
79
Injury assessment: What are the key things to note when doing a pelvic ring stability test?
-If the pressure reveals any instability or crepitus or elicits a response of pain from the patient, suspect pelvic fracture
80
Injury assessment: What is crepitus, as experienced in a pelvic ring stability check?
Crepitus is a grating sensation felt as bone ends rub against one another; if feel crepitus during check, presume bone injury exists and do not attempt to recreate the sensation
81
Injury assessment: Failure to ___ an injury properly may lead to additional soft, ___, connective, ___, and nervous tissue damage.
immobilize ; skeletal ; vascular
82
Injury assessment: When should you suspect compartment syndrome in any patient?
Any patient who has any paraesthesia (especially in the webs between the medial toes or fingers); who has an extremity injury with firm mass o increased skin tension at the injury site; or who has pain out of proportion to the nature of the injury/pain that increases when you move the limb
83
Injury assessment: What are early indicators of compartment syndrome?
- Feelings of tension within limb
- Loss of distal sensation (especially in webs of fingers or toes)
- Complaints of pain
- Condition more severe than mechanism of injury would indicate
- Pain on passive extension of extremity
- Pulse deficit (late sign)
84
Physical exam: When are you most likely to perform a physical exam on a patient?
One who is unconscious or lowered level of consciousness
85
Sport injury: What should you assess when dealing with sport injuries?
- Assess the mechanism of injury
- Determine whether there was a major kinetic force involved, a hyperextension or flexion injury, or a fatigue-type injury
86
What two fractures contribute significantly to hypovolemia and shock?
Pelvis and (lesser degree) femur
87
Injury management: What is the general process for musculoskeletal injury management?
Protect open wounds, position the extremity properly, immobilizing the injured extremity, and monitoring neurovascular function in the distal limb
88
Injury management: When should you consider a fracture/dislocation an open one?
If there is any open wound in close proximity to the fracture or dislocation
89
Injury management: What is an expected consequence of proper care when protecting the wound?
Attempts to align the limb, the splinting process, or the application of traction will draw protruding bones back into the wound
90
Injury management: What are the key benefits to positioning the injured limb?
Ensures patient's comfort; reduce canes of further limb injury; and encourage venous drainage
91
Injury management: When is limb alignment appropriate for fractures?
For mid-shaft femur, tibia/fibula, humerus, or radius/ulna
92
Injury management: Stop ___ attempts when you detect any ___ or when the patient reports any significant ___ in pain.
realignment ; resistance ; increase
93
Injury management: You should not attempt alignment of dislocations/serious injuries within ___ inches of a joint (generally) unless distal circulation is compromised.
3
94
Injury management: What is the position of function?
Placing the uninjured joints of the limb halfway between flexion and extension; places the least stress on the joint ligaments and muscles/tendons surrounding the injury
95
Injury management: What is the aim of immobilizing musculoskeletal injuries?
Prevent further injury caused by the movement of broken bone ends and bone ends dislodged from a joint and by further stress placed on muscles/ligaments/tendons already injured by a strain, sprain, subluxation, dislocation, or fracture
96
Injury management: Why are long bones difficult immobilize directly? How do you account for this?
Long bones lie buried deep within the musculature of the extremities; immobilize the joint above and below the injury regardless of whether the injury occurs at joint or mid-shaft
97
Injury management: How should a splint be wrapped and why?
From a distal point to a proximal one; ensures the pressure of bandaging moves any blood into the systemic circulation and does not trap it in the distal limb - assists venous drainage and healing process
98
Splinting devices: How might an aligned injured limb be wrapped? An angulated limb?
Aligned limb - circumferential wrapping
Angulated limb - cross wrapping at two locations
99
Fracture care: What is the definition of a joint injury versus a fracture? Why is this distinction important?
- Joint injury: muscular/connective tissue injury/dislocation/fracture within 3 inches of a joint
- Fractures: shaft injuries at least 3 inches away from the joint
- Important because injury near the joint carries a higher incidence of blood vessel and never involvement and requires a different approach to positioning and splinting
100
Joint care: What is reduction? What are the benefits and hazards of reduction?
Reduction is the returning of displaced bone ends to their proper anatomical orientation.
Benefits: Reduces stress on ligaments/basic joint structures, facilitates better distal circulation and sensation
Hazards: risk of trapping blood vessels/nerves as the bone ends return to normal anatomical position
101
Joint care: Why would you consider doing a reduction?
- Positive injury IS a dislocation
- Delayed patient arrival to ER (prolonged extrication, long transport)
- Significant neurovascular deficit
102
Joint care: When is reduction not appropriate?
If dislocation is associated with other serious patient injuries
103
Muscular and connective tissue care: What is the first step in managing muscle/tendon/ligament injuries? Why?
Immobilize the region surrounding the injury; reduces associated internal hemorrhage and pain - provide gentle circumferential bandaging to further reduce hemorrhage/edema/pain
104
Specific fracture care: While ___ ___ fractures may reflect serious trauma, they do not represent patient life threat suggested by ___ ___ fractures.
iliac crest ; pelvic ring
105
Specific fracture care: Which pelvic fracture is often isolated and stable injury that you can care for with simple patient immobilization?
Iliac crest
106
Specific fracture care: the ring shape of the pelvis provides ___ to the structure, but when it breaks ___ fracture sites usually result.
strength ; two
107
Specific fracture care: What can pelvic ring injury result in or lead to?
- Heavy hemorrhage that can result in circulation loss to one or both lower extremities
- Hemorrhage likely to empty into the pelvic and retroperitoneal spaces and account for blood loss in excess of 2 liters
- Hip dislocations
- Injuries to female reproductive organs, urethra, prostate, and end of the alimentary canal (anus and rectum)
108
Specific fracture care: If a pelvic ring fracture patient is ___, start ___ large-bore IVS and hang ___ 1,000-mL bags of lactated Ringer's solution/normal saline.
hypotensive ; two ; two
109
Specific fracture care: For a pelvic ring fracture patient, set up using ___ ___ and administer fluid boluses as needed to maintain systolic blood pressure of at least ___ mmHg.
trauma tubing ; 80
110
T or F. Pelvic fracture patients should be considered candidates for rapid transport.
True
111
Specific fracture care: ___ femur fractures may be splinted by gently placing the patient on a long spine board.
Atraumatic
112
Specific fracture care: ___ fractures (surgicaal neck and intertrochanteric fractures) are frequently caused by hip injuries, transmitted forces, or degenerative effect of aging.
Proximal fractures
113
Specific fracture care: ___ fractures often result from high-energy, lateral traumas and are associated with significant blood loss.
Midshaft
114
Specific fracture care: Injuries to the ___ femur can be extensive and are likely to involve blood vessels, nerves, and connective tissue
distal
115
Specific fracture care: If a pelvic fracture is suspected with a femur fracture, do not apply a ___ splint.
traction; may apply pressure to the fractured pelvis causing further bone displacement and hemorrhage
116
Specific fracture care: How will a femur fracture present?
Foot externally rotated (turned outward) and injured limb shortened when compared to the other (may be slight or unnoticeable)
117
Specific fracture care: What is the general femur fracture care process?
- Align the limb
- Determine status of circulation, sensory and motor function
- Apply the traction splint
118
Specific fracture care: How to use a traction splint.
- Adjust length of splint toe uninjured extremity
- Position device against the pelvis
- Secure it in position with the inguinal strap
- --(A) Bipolar splint: apply ankle hitch, provide gentle traction, and elevate the distal limb to place splint's ring against the ischial tuberosity
- --(B) Unipolar splint: position T-shaped support against pubic bone and simply apply the angle hitch
- Ensure hitch and splint hold foot and limb in an anatomical position as you apply firm traction
- Position and secure limb to splint with straps
119
Specific fracture care: What is the most commonly fractured leg bone?
Tibia
120
Specific fracture care: ___fractures are relatively stable while ___ fractures are not.
Fibular ; tibial
121
Specific fracture care: ___ fracture is likely to cause an open wound. ___ fractures are often associated with damage to the knee or ankle.
Tibial ; fibular
122
Specific fracture care: What is the general process for tibia/fibula fracture care?
- Align the injured limb
- Assess circulation, sensation, and motor function
- Immobilize limb with gentle traction.
- ---full-leg air splint, vacuum, or lateral and medial padded rigid splints effective
- Secure immobilized limb to uninjured leg
123
Specific fracture care: What is the most frequently fractured bone in the body?
Clavicle
124
Specific fracture care: Clavicle fractures usually result from ___ forces directed along the ___ extremity that cause relatively ___ skeletal injury.
transmitted ; upper ; minor
125
Specific fracture care: How does a clavicle fracture patient usually present?
- Pain
- Shoulder shifted forward
- Palpable deformity along clavicle
126
Specific fracture care: How do you splint a clavicle fracture?
Either by immobilizing the affected limb in a sling and swathe or by wrapping a figure-eight bandage around the shoulders and secure bandage with tension which draws the shoulders back
127
Specific fracture care: Why is a fractured humerus difficult to immobilize at its proximal end?
Proximal humerus is buried within shoulder muscles, and the shoulder joint is very mobile atop the thoracic cage; axillary artery runs through the axilla making it difficult to apply any mechanical traction to the limb without compromising circulation
128
Specific fracture care: What is the preferred technique to immobilize the humerus? What is the general process?
Sling and swathe
- Apply short padded rigid splint to the lateral surface of th arm
- Sling the forearm with cravat, catching just the wrist region not the elbow (permits some gravitational traction in the seated patient)
- Use several cravats to swathe the arm and forearm to the chest
- If patient is conscious: have them place thumb of uninjured extremity in the fold of the elbow to help control injured limb's motion
129
Specific fracture care: What is the less preferred method to immobilize the humerus fracture?
- Affix long padded rigid split to extended limb
- --Place splint along medial aspect of upper extrimity and ensure it does not apply pressre to axilla
- ---Secure splint firmly to limb wrapping from distal end toward proximal end
- Secure the splint to the supine patient's body
130
Specific fracture care: Forearm fractures occur most commonly at the ___ end of the radius just above the ___ surface. Also known as ___ fracture.
distal ; articular ; Colles'
131
Specific fracture care: How does the Colles' fracture usually present?
Wrist turned upward at a unusual angle
132
Specific fracture care: What is another term for Colles' fractures?
Sliver fork deformity because it is contoured like a fork and the distal limb often becomes ashen
133
Specific fracture care: What are the chief concerns with Colles' fractures/"silver fork deformity"?
Distal circulation and innervation
134
Specific fracture care: What is the general process for forearm fracture care?
- Splint with a sort, padded rigid split affixed to the forearm and hand
- Secure the hand in the position of function by placing a large wad of dressing material in the palm to maintain a position like that of holding a large ball
- Place rigid splint along the medial forearm surface and wrap circumferentially from fingers to elbow (leave at least one digit exposed for capillary refill checks)
- Bend elbow across chest and use sling and swathe to hold limb in position
135
Specific joint injury care: Hips may dislocate ___ or ___.
Anteriorly ; posteriorly
136
Specific joint injury care: How does anterior hip dislocation present?
Foot turned outward, hip and knee flexed, and head of femur sometime s palpable in the inguinal area
137
Specific joint injury care: How does posterior hip dislocation present?
Knee flexed and foot rotated internally; displaced head of femur is buried in the muscle of the buttocks
138
Specific joint injury care: What is the general process for hip dislocation care?
- Immobilize either type of dislocation on a long spine board using pillows and blankets as padding to maintain patient's position
- If distal circulation, sensation, or motor function is severely compromised: consider one reduction attempt (based on protocols); anterior dislocations cannot be reduced in prehospital setting
139
Specific joint injury care: How to perform a posterior hip dislocation reduction.
- Have care provider hold pelvis firmly against long sine borad or other firm surface by placing downward pressure on iliac crests
- Flex both patient's hip and knee at 90 degrees and apply firm, slowly increasing traction along axis of the femur
- Gently rotated femur externally
- --It takes time for muscles to relax but when they do the femur will "pop" back into position
- ---If hear "pop" or patient has relief of pain, reduction most likely a success
- Immobilize patient in flexion (not to exceed 90 degrees) or fully supine with the hip and leg in full extension
- Reevaluate sensation, motor function, and circulation
140
Specific joint injury care: What all can knee injuries include?
Fractures of the femur/tibia/both; patellar dislocations; or frank dislocations of the knee
141
Specific joint injury care: Why are knee dislocations of great concern?
- Large joint and bears a a great amount of weight
- Injury threatens patient's future ability to walk
- Possible injury to major blood vessel traversing the area (the POPLITEAL ARTERY)
- ---This artery is less mobile than blood vessels in other joints which leaves it more subject to injury and distal vascular compromise
142
Specific joint injury care: Immobilize ___ ___ ___ and ___ ___ in the position found unless distal circulation, sensation, or motor function is disrupted.
knee joint fractures ; patellar dislocations
143
Specific joint injury care: What is the general process for knee joint injury care?
- Immobilize in position found
- ---If flexed: splint with 2 medium rigid splints placing one medially and one laterally; cross-wrap with bandage material to secure limb in position; may use ladder or malleable splints conformed to angle of limb and placed anteriorly and posteriorly
- ---If extended: apply two padded rigid splints or full-leg air splint
144
Specific joint injury care: Dislocation of the ___ is more common than dislocation of the ___ ___. Usually leaves knee in a flexed position with a ___ displacement of the ___.
patella ; knee joint ; lateral ; patella
145
Specific joint injury care: What are the differences between anterior and posterior dislocations of the knee?
- Anterior dislocations: produce an extended limb contour that lifts at the knee (moving from proximal to distal)
- Posterior dislocations: produce a limb that drops at the knee
146
Specific joint injury care: Ankle injuries often produce a ___ ___ limb that is grossly deformed, either due to ____ fracture, ___, or both.
distal lower ; malleolar ; dislocation
147
Specific joint injury care: What is the general process for ankle injury care?
Splint sprains or non-displaced fractures with an air split or long rigid splint position on either side o the limb (padded liberally and wrapped firmly); apply local cooling to ease pain and reduce swelling
148
Specific joint injury care: What three directions can ankle dislocations occur?
- Anteriorly
- Posteriorly
- Laterally
149
Specific joint injury care: How do anterior ankle dislocations present?
Dorsiflexed (upward-pointing) foot that appears shortened
150
Specific joint injury care: How do posterior ankle dislocations present?
Appears to lengthen the plantar flexed (downward-pointing) foot
151
Specific joint injury care: How do lateral ankle dislocations present?
Foot turned outward with respect to the ankle; most common
152
Specific joint injury care: What is the general reduction process for ankle dislocation injuries?
- Have care provider grasp calf, hold it in position, and pull against the traction you apply
- You then grasp the heel with one hand and metatarsal arch with the other
- Pull a distal traction to disengage bone ends and protect articular cartilage during relocation
- ANTERIOR: move the foot posteriorly with respect to the ankle
- LATERAL: rotate the foot medially
- POSTERIOR: pull the heel toward you and the foot toward you then away
- Joint should return to normal position with a "pop", reduction in pain, and increase in mobility of the joint.
153
Specific joint injury care: Injuries to the foot include ___ and ___ of the calcanei (heel bone), metatarsals, and phalanges.
dislocation ; fractures
154
Specific joint injury care: ___ fractures of the metatarsal bones, or "___ fractures" are relatively common.
Fatigue ; march
155
Specific joint injury care: When foot or ankle injury is suspected, anticipate both ___ foot injuries and ___ spinal injury.
bilateral ; lumbar
156
Specific joint injury care: How do you immobilize foot injuries?
Similar to ankle injuries - use pillow, vacuum, ladder, or air splints (with ankle accommodation
157
Specific joint injury care: What is most commonly involved in fractures of the shoulder?
The proximal humerus, lateral scapula, and distal clavical
158
Specific joint injury care: Dislocation can include ___, ___, and ___ displacement of the humeral head.
anterior ; posterior ; inferior
159
Specific joint injury care: How do anterior dislocations present?
Displace the humeral head forward resulting in a shoulder that appears "hollow" or "squared off" with the patient holding the arm close to the chest and forward of the midmaxillary line
160
Specific joint injury care: How do posterior dislocations present?
Rotate the arm internally and the patient presents with the elbow and forearm held away from the chest
161
Specific joint injury care: How do inferior dislocations present?
Displace the humeral head downward with the result that the patient's arm is often locked above the head
162
Specific joint injury care: How do you immobilize anterior and posterior dislocations?
With a sling and swathe, and if needed, a pillow under the arm and forearm
163
Specific joint injury care: How do you immobilize inferior dislocations?
Requires ingenuity - just maintain position found in; use cravats, tie a long, padded splint to the torso, shoulder girdle, arm, and forearm to immobilize the arm above the head
164
Specific joint injury care: How do you perform an anterior or posterior shoulder dislocation reduction?
- Place a strap across the patient's chest, under the affected shoulder (through the axilla) and across the back
- Have a care provided prepared to pull counteraction across the chest and superiorly using the strap
- You should flex the patient's elbo drawing the arm somewhat away from the body (abduction) and pull firm traction along the axis of the humerus
- ---Some slight internal and external rotation of the humerus may facilitate reduction
165
Specific joint injury care: How do you perform inferior dislocation reductions?
- Have one care provider hold the thorax while you flex the elbow
- Gradually apply firm traction along the axis of the humerus and gently rotate the arm externally
- ---If reduction unsuccessful: immobilize and transport
- ---If reduction successful: sling and swathe in anatomical position
166
Specific joint injury care: The probability is good that an elbow fracture or dislocation will involve the ___ artery and the ___, ___, and ___ nerves
brachial ; medial ; ulnar ; radial
167
Specific joint injury care: How do you provide elbow dislocation/fracture injury care?
- Assess for distal neurovascular function
- ---If detect deficit, move joint carefully and minimally to restore distal circulation
- Splint with a single padded rigid splint, providing cross-strapping as necessary or use a ladder splint bent to conform to the angle of the limb
- Sling and swathe with the wrist slightly above the elbow (increases venous return and reduces swelling/pain)
168
Specific joint injury care: Fractures of the hand and wist are commonly associated with ___ trauma.
Direct
169
Specific joint injury care: How do hand/wrist fractures present?
Very noticeable deformity and significant pain; serious concern to the patient; because bones are small any fracture is in close proximity to a joint
170
Specific joint injury care: What is a chief concern with hand and wrist fractures?
Possibility of vascular and neural involvement
171
Specific joint injury care: How do you immobilize forearm, wrist, hand, or finger injuries?
With a padded rigid, vacuum, or air splint; place a wad of padding/similar object in patient's hand to maintain the position of function; place the wrist above the elbow to assist venous return and reduce distal swelling
172
Specific joint injury care: Displacement usually occurs between the phalanger or between the ___ ___ and the adjacent ___ and moves the bone either ___ or ___.
proximal phalanx ; metacarpal ; anteriorly ; posteriorly
173
Specific joint injury care: How do you care for finger injuries?
Splint finger using tongue blades or small, malleable splints; may also tape to adjoining fingers to limit additional motion; place hand in position of function and further immobilize
174
Specific joint injury care: How do you perform finger dislocation reductions?
- Grasp the distal finger and apply firm distal traction
- Direct the digit toward the normal anatomical position by moving its proximal end
- Should feel finger "pop" into place ad move to normal alignment
- Splint finger with slight bend (10-15 degrees) and immobilize hand in position of function
175
Soft and connective tissue injuries: Tendon, ligament, and muscle injuries are ___ life threatening. They can endanger the ___ ___ of the limb though.
Rarely ; future function
176
Soft and connective tissue injuries: How should you treat soft/connective tissue injuries?
Like a dislocation - immobilize the adjacent joints; monitor distal neurovasular function; gentle compression with snug dressings; and local cooling to suppress edema and pain
177
Soft and connective tissue injuries: Injury to muslce/tendon may limit its ability to either ___ or ___ the limb. The opposing muscle moves the limb, while the injured muscle can't ___ it to normal position.
extend ; flex ; return
178
Medications: What is the name of the drug that is a benzodiazepine with both anti-anxiety and skeletal muscle relaxant qualities, but does not have pain relieving properties?
Diazepam (Valium)
* Reduces patient's perception and memory of pain
* Think diazepam = DAZE-pam ;)
179
Medications: Diazepam is used with ___ injuries and to premedicate patients before painful procedures such as ___ and ___ ___.
musculoskeletal ; cardioversion ; dislocation reduction
180
Medications: How is diazepam administered?
- Slow IV bolus
- 5 to 15 mg, NTE 5 mg/minute
- Into large vein
181
Medications: Diazepam is relatively ___ acting and reaches peak effectiveness in ___ minutes with total effectiveness from ___ to ___ minutes.
fast ; 15 ; 15 ; 60
182
T or F. You can mix diazepam with other drugs and should be injected into the plastic IV bag.
FALSE - it should NOT be mixed with other drugs NOR injected into the plastic IV bag because it is readily absorbed by plastic which reduces its concentration
183
Medications: How is diazepam usually supplied?
In single-use vials or preloaded syringes containing 2 mL of a 5 mg/mL solution (10 mg)
184
Medications: How do you reverse the effects of diazepam?
- Administer flumazenil
| - ---Usually 2 mL of a 0.1 mg/mL solution is given IV (over 15 seconds) with a second dose repeated at 60 seconds
185
Medications: What is the name of the drug that is an opium alkaloid used to relieve pain (narcotic analgesic), to sedate, and to reduce anxiety?
Morphine sulfate (Duramorph, Astramorph)
186
Medications: Morphine may reduce ___ volume and cardiac preload by increasing ___ capacitance and may thus decrease ___ ___ in the ___ patient.
vascular ; venous ; blood pressure ; hypovolemic
187
Medications: What are the major side effects of morphine?
Respiratory depression, nausea, vomitting
188
Medications: How is morphine usually supplied?
- In 10-mL single-use vials
- Tubex units of a 1 mg/mL solution
- As 1 mL of a 10-mg/mL solution vial
--For dilution with 9 mL normal saline
189
Medications: How is morphine administered?
2-mg bolus slowly IV, repeating as necessary every few minutes to effect
190
Medications: What can reverse the effects of morphine (or narcotics in general - morphine, fentanyl, nalbuphine)? How is it administered?
Naloxone hydrochloride (Narcan) - narcotic antagonist
Administered as an IV bolus of 0.4 to 2 mg, repeated every 2 to 3 minutes until effective; shorter-acting drug than morphine so repeat doses may be necessary
191
Medications: What is the name of the drug that is an opiate narcotic, chemically unrelated to morphine, and provides immediate/effective pain control?
Fentanyl
192
Medications: What are advantages of fentanyl over morphine?
-Onset of action is more rapid
_considerably more potent (thus requiring lower doses)
-Does not cause hypotension to the same degree
193
Medications: How is fentanyl supplied?
Various doses - typical starting does is 25 to 50 mcg IV; repeat doses of 25 mcg IV can be provided as needed
194
Medications: What is the name of the drug that is a synthetic narcotic analgesic wit properties much like morphine, equivalent on a mg-to-mg basis to morphine (although it antagonizes some of the actions of that drug)?
Nalbuphine hydrochloride (Nubain)
195
Medications: Nalbuphine does not generally decrease ___ ___ but may produce ___ ___ and ___.
blood pressure ; respiratory depression ; bradycardia
196
Medications: Nalbuphine is ___ acting - usually within ___ to ___ minutes - and long effectiveness duration of ___ to ___ hours.
fast ; 2 ; 3 ; 3 ; 6
197
Medications: How is Nalbuphine supplied?
Ampules or preloaded syringes containing 1 mL of a 10 or 20 mg/mL solution
198
Medications: How is Nalbuphine administered?
IV in a does of 5 mg then 2 mg repeated as needed up to 20 mg
199
Medications: What will reverse the effects of nalbuphine?
Narcan
200
___ fractures disrupt the child's growth plate and endanger future bone growth.
Epiphyseal
201
What acronym do athletic trainers use to identify the recommended treatment for sprains, strains, and other soft-tissue injuries?
RICE ---
R: rest the extremity
I: ice for the first 48 hours
C: compress with elastic bandage
E: elevate extremity
202
Overexertion can cause what type of muscle injury?
Muscle fatigue, cramp, or strain
203
Joints can move beyond their normal range of motion with great enough applied force. This movement causes a complete displacement of bone ends from their normal position, is known as a(n) ___ and is characterized by ___.
dislocation ; characterized by pain, edema, and immobility
204
A grade ___ sprain may present as a fracture.
III (3)
205
A small crack in bone that does not disrupt its total structure is called a(n) ___ fracture.
Hairline
206
A break in a bone in which the bone is compressed on itself is known as:
Impacted fracture
207
A common disintegration of the articular joints often associated with the aging process describes degenerative joint disease. Another disorder, characterized by inflammation f the synovial joints and causing immobility, pain, and fatigue is known as ___ ___.
Rheumatoid arthritis
208
A thickened area that forms at the site of a fracture is called a(n) ___.
Callus
209
A femur fracture may account for as much as ___ mL of blood loss.
1,500
210
You should stop attempts to realign a limb with a suspected fracture if:
The patient reports a significant increase in pain
211
Ladder splints, metal sheet splits, and vacuum splints are examples of ___ splints.
formable
212
Your patient has been involved in a motor-vehicle collision. You suspect concurrent femur and pelvic fractures. Treatment of this patient would best be provided by:
PASG, supportive oxygen and fluid therapies, transport to trauma center
213
The term reduction refers to:
Returning displaced bone ends to normal position
214
What is an open reduction?
Use of surgery to place bones
215
What is internal fixation?
Wires, pins, screws, to place bones
216
How are cravats used?
Goes around extremities
217
How is a sling used?
Goes around neck to hold up arm
218
Ligaments support ____ to ____.
Bone to bone
219
Tendons support _____ to _____.
Muscle to bone
220
The point of origin _______ during contraction.
Doesn't move
221
The point of insertion ________ during contraction.
Moves
222
Most common open fractures are _______ and ____.
Tibia
| Fibula
223
What is subluxation?
Pulling of joint apart and goes back in
224
____ is a complete dislocation.
Luxation
225
A strain is a pulled ________.
Tendon (muscle)
226
Strains occur when?
Lifting something heavy
227
How long is healing time with strains?
Days to weeks to heal
228
A sprain is?
Ligament damage
229
Sprains take how long to heal?
8 months
230
1st degree of sprain has?
No joint instability
231
2nd degree sprain has?
Swelling and bruising but joint intact
232
3rd degree sprain has?
Ligaments completely torn
233
Bursitis is?
Inflammation of bursa
234
Tibia/fibula fractures bleed about ____ml.
500ml
235
What is priority - unstable pelvis or femur?
Unstable pelvis
